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Prevalence and Risk of Plasmodium falciparum and P. vivax Malaria among Pregnant Women Living in the Hypoendemic Communities of the Peruvian Amazon

The Amazon region of Iquitos, Peru is hypoendemic for Plasmodium vivax and P. falciparum. There is limited information regarding the epidemiology of malaria during pregnancy in this region. Passive surveillance for clinical malaria among pregnant women was conducted in eight health posts in 2004 and 2005. Community-based active surveillance was conducted to determine the incidence of malarial infection among pregnant women in the community of Zungarococha in 2004 and 2005. Passive surveillance demonstrated that pregnant women had a prevalence of clinical malaria of 7.5% in 2004 and 6.6% in 2005 compared with 20.6% and 22.4% of the total population. Active surveillance showed that pregnant women were 2.3 (95% confidence interval = 1.32–3.95, P = 0.004) times more likely to have a P. falciparum infection compared with non-pregnant women. This study demonstrated that because of detection bias, passive surveillance underestimates the burden of malarial infection during pregnancy, and that subclinical malarial infections may occur frequently among pregnant women in this region. Furthermore, pregnant women in this low-transmission and P. vivax–dominant setting, experience an increased risk for P. falciparum infection, but not P. vivax infection.

Received November 10, 2006. Accepted for publication May 1, 2007.

Financial support: This study was supported by the Gorgas Memorial Institute, the Centers for Disease Control and Prevention (grant UR3/CCU 418652 to for Falgunee K. Parekh), and the American Society of Tropical Medicine and Hygiene.

^* Address correspondence to Oralee H. Branch, Division of Geographic Medicine, Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, BBRB 554, Birmingham, AL 35294-2170. E-mail: obranch{at}uab.edu

Authors’ addresses: Falgunee K. Parekh, 1620 East Jefferson Street, 206, Rockville, MD 20852, Telephone: 301-319-9920. Jean N. Hernandez and Oralee H. Branch, Division of Geographic Medicine, Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, BBRB 554, Birmingham, AL 35294-2170, Telephone: 205-934-4721, Fax: 205-934-5600, E-mail: obranch{at}uab.edu. Donald J. Krogstad, Tulane University School of Public Health and Tropical Medicine, 1440 Tulane Avenue, New Orleans, LA, Telephone: 504-988-3552. W. Martin Casapia, Asociacion Civil Selva Amazonica, Calle Fanning, Cdra. 4 Iquitos, Loreto, Peru, E-mail: mcasapia{at}acsaperu.org.